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Is hormone therapy necessary with radiation?
A few different people have asked about this in the last few days so here is some information about it.
Advantage of radiation and hormone therapy given at the same time greatly reduced
Overall survival—the chance of being alive years later—was nearly the same whether or not men received hormones with their radiation. After 10 years of follow‑up, 83.6% of men treated with radiation alone were alive, compared with 84.3% of men who also had hormone therapy, a difference of only 0.7%. Statistically, that small gap did not reach the usual bar for significance, meaning it may simply be due to chance.
However, the story changed when researchers looked at PSA level before radiation. Men whose PSA was 0.5 ng/mL or lower when they started radiation did not live longer if they added hormone therapy—whether they took it for a few months or for two full years. Men whose PSA was higher than 0.5 ng/mL, on the other hand, did see some survival benefit from adding hormones, suggesting that hormone therapy makes the most sense for this higher‑risk group.
The study also examined how long hormone therapy should last. Short‑term therapy (about 4–6 months) performed just as well as long‑term therapy (about 24 months) for most men in terms of overall survival. Longer treatment appeared to reduce the chance of the cancer spreading, but it did not clearly translate into men living longer overall in the general study population. Based on these data. Kishan summarized: for men who truly need it, a short course of hormone therapy is usually enough.
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@bikeman1 How did you get set up with Dr. Paller? That seems like someone I would like to consult with.
@jim18
That is exactly what I am struggling with. My PSA was low when I started treatment, so I keep wondering how much benefit there really is after 12 months. At the same time, I know my pathology and Decipher score were high risk, so I understand why my doctors are recommending longer.
I am not trying to ignore the guidelines or pretend I know more than the doctors. I am just trying to figure out whether the possible added reduction in recurrence risk from going beyond 12 months is worth the impact ADT has on my quality of life.
@tj1967 Very fair question but I want to add a big caveat to the study Jeff cited, and I believe Jim just referenced. Looking at all-cause mortality as an endpoint to a study for the effectiveness of ADT can be misleading. In essence, it is saying men who get ADT will die at the same rate as the general population. Studies like SPPORT trial show a lessening benefit of ADT after 6 months, but those studies clearly show ADT decreases progression, decreases time to metastasis, and decreases the risk of mortality due to prostate cancer. The Lancet paper changes none of that. Further in the paper, that point is acknowledged. So if the focus is on disease-free time to progression or delaying metastasis, then ADT becomes important.
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2 Reactions@dhasper
My RO at J Hopkins (dr Greco) referred me. But you might be able to call cold and get an appointment, albeit it could be a long time from now.
@jeffmarc
Thanks for the tips, Jeff. And I should thank you for recommending her in the first place.
Also on the subject of length of time on the drugs, she recommends two years for me (for both drugs) because two lymph nodes were positive.
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1 Reaction@dhasper
I do think these studies all show that those that have aggressive cases of prostate cancer cannot go by the short term ADT treatments. In those cases, they usually need more time in order to have a PFS.
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4 ReactionsIn this presentation you all will find answers for all of your questions (or 99% of questions) . It is long, grab cup of your fav. beverage and read on. And yes, wording matters - most people look for "overall survival" and that should not be the case since patients are generally older and die for many reasons, reasons that are not even related to PC NOR PC treatment side effects. I wish that all studies involve PC related deaths ! Some do have it and than one can see that OS is not the same as cancer related death. Anyways - here we go :
https://www.urotoday.com/conference-highlights/asco-gu-2024/asco-gu-2024-prostate-cancer/149384-asco-gu-2024-salvage-radiotherapy-options-for-biochemical-recurrence-after-local-treatment.html
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1 Reaction@jeffmarc Yes and your original comment made that clear Jeff. Since then I have spent some time with that study and am going to write something later longer.
@surftohealth88 I will rad through this. Yes when I started reviewing the Lancet article I stopped and said 'what a minute what is the 10 year survival rate for a 10 year old man that never had prostate cancer". Then you realize that these all cause mortality numbers are a very questionable metric.
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1 Reaction@tj1967 Only you can decide how much your quality of life is suffering. Are you losing bone mass? Increased calcification of arteries? heart issues? Was nerve sparing done and are you doing rehabilitation? If your RT included pelvic nodes RT that improves overall progression free time so reduces the amount additional months of ADT will benefit. The Radicals trial showed a 78% (24 mth) vs 72% (6 mth) metastases free survival after 10 years with no difference in overall survival. No info on 12 or 18 months but should fall in between.
## From the surftohealth link (above):
# Salvage radiotherapy + 6 months of ADT should be used for patients with PSA > 0.5 ng/mL or high-risk features (pT3b/4 and/or grade group ≥4 and/or high Decipher).
# Salvage radiotherapy + 2 years of ADT should be reserved for very select high-risk patients
# Elective pelvic nodal radiotherapy improves freedom from progression and time to second salvage ADT in the SPORT trial
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